How Can We Better Understand Neurodevelopmental Disorders and Neurodiversity?

What you need to know

• Neurodevelopmental disorders (NDDs) like autism and ADHD are increasingly recognized as important in adult mental health services.
• There are differing perspectives on NDDs from medical, social, and neurodiversity viewpoints that can be reconciled.
• Understanding key terms and concepts related to neurodiversity can improve clinical practice and support for individuals with NDDs.

Understanding Neurodevelopmental Disorders

Neurodevelopmental disorders (NDDs) are conditions that affect brain development and functioning, typically beginning in childhood. Two of the most prominent NDDs are attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). While these conditions have long been recognized in children, there is growing awareness of their impact on adults as well.

For mental health professionals working with adults, understanding NDDs is crucial. Adults with ADHD or autism often have co-occurring mental health conditions, with research showing that on average, adults with ADHD experience three additional psychiatric disorders. Furthermore, about 70% of individuals eventually diagnosed with ADHD or autism first seek help for other mental health concerns.

Recognizing the presence of an NDD in a patient can significantly change how clinicians understand and treat their symptoms. For example, knowing that a person with depression is also autistic may lead to different treatment approaches and a better understanding of their experiences. Unfortunately, many adults with NDDs report negative experiences with mental health services, feeling misunderstood or not taken seriously.

Key Concepts in Neurodevelopmental Disorders

To improve understanding and clinical practice, it’s helpful to define some key terms related to NDDs:

1. Neurocognitive functions: These are specific aspects of brain functioning, such as attention, emotion regulation, impulse control, sensory processing, and social behaviors. These traits are present from birth and may be significantly influenced by genetics.

2. Neurodevelopment: This refers to how neurocognitive functions change and develop over time, particularly during childhood and adolescence.

3. Neurodiversity: This term describes the natural variation in neurocognitive functions within a population. It’s important to note that neurodiversity is a characteristic of the entire population, not of specific individuals.

4. Neurotypical: This describes individuals whose neurocognitive functions fall within what society considers “normal” for their age.

5. Neurodivergent: This term refers to individuals whose neurocognitive functions fall outside societal norms. Importantly, being neurodivergent doesn’t necessarily mean a person has a disorder or experiences impairment.

6. Neurodevelopmental disorder or condition: This term is used when an individual’s neurocognitive function is at an extreme for their age and is associated with significant functional impairment.

Medical and Social Perspectives on NDDs

The medical perspective on NDDs, as reflected in diagnostic manuals like the DSM-5 and ICD-11, views these conditions as lifelong traits that exist on a spectrum within the population. Diagnosis is typically given when traits fall “outside the limits of normal variation” and cause significant functional impairment.

This perspective recognizes two groups within conditions like ADHD and autism:

1. A larger group with traits at the extreme end of normal variation who experience significant impairment
2. A smaller group with traits that fall outside normal variation, often due to specific genetic or neurological conditions

The social perspective, often associated with the neurodiversity movement, views NDDs as part of natural human variation rather than disorders. This viewpoint emphasizes that society’s norms and expectations can disadvantage neurodivergent individuals, and that the focus should be on creating more inclusive environments rather than trying to “fix” or “normalize” neurodivergent people.

Reconciling Different Perspectives

While these perspectives may seem at odds, they actually agree on several important points:

1. There is natural variation in neurodevelopment across the population.
2. Most individuals diagnosed with ADHD or autism fall at one end of this normal variation rather than being fundamentally different.
3. Environmental adjustments and supports are crucial, rather than trying to change a person’s fundamental neurocognitive traits.

The main point of disagreement is around the concept of impairment. The medical model requires significant impairment for a diagnosis, while the neurodiversity perspective sees neurodivergence as a valid identity even without impairment.

Implications for Clinical Practice

Understanding these concepts and perspectives can help mental health professionals provide better care for neurodivergent individuals:

1. Recognize that NDDs are common and often co-occur with other mental health conditions.
2. Be aware that adults with undiagnosed NDDs may first present with other mental health concerns.
3. Consider how an NDD might influence a person’s presentation and treatment needs, even if it’s not the primary reason they’re seeking help.
4. Focus on environmental adaptations and supports rather than trying to “normalize” neurodivergent traits.
5. Be sensitive to language preferences - some individuals prefer identity-first language (e.g., “autistic person”) while others prefer person-first language (e.g., “person with autism”).
6. Recognize that impairment can result from societal barriers and lack of understanding, not just from inherent traits.

Conclusions

• Understanding neurodevelopmental disorders and neurodiversity is crucial for providing effective mental health care to adults.
• There are multiple valid perspectives on NDDs, including medical and social viewpoints, which can be integrated for a more comprehensive understanding.
• Focusing on environmental adaptations and supports, rather than trying to “fix” neurodivergent individuals, can lead to better outcomes and more inclusive mental health services.